Tigheaven Ltd

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We found the provider to be in breach of 1 legal regulation in relation to need for consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Initial assessments were carried before people started using the service to ensure their needs could be met. People and relatives were involved in the assessments to enable them to make an informed choice about their care. A person told us, “The manager came out and did all the paperwork and put it in a folder which they leave here and the carers write in it every day.” A relative told us, “When they took over the care, the manager came to the house and talked through everything.” Another relative told us, “They came and talked through everything before [person] started. They asked about their history, medical condition and the support we needed.”

However, initial assessments had not been used to develop people’s care plans to ensure care and support was planned and continually provided in accordance with people’s needs.

People and relatives told us they received the support they needed to eat and drink. A person told us, “They just heat my food in the microwave but that’s all I need.” A relative told us, “The carers sort out [persons] food. I make it and they heat it up or give them a sandwich depending on the time of day. [Person] always has drinks.” Another relative told us, “No problems with food, [person] can eat normally and the carers just sort out what [person] chooses.”

However, care records did not contain any information and guidance on people’s dietary needs and individual preferences. There was no information recorded which showed how people were to be supported with their food and drink and did not identify any potential risks and if they had any specific dietary requirements. For example, for a person who received their care in bed, care records stated ‘Feeding support which includes ensuring [persons] breakfast, lunch, dinner and drinks’ with no further information on what support the person required and how this was to be done safely. Therefore, people were at risk of not receiving the appropriate support in accordance with their individual nutritional and hydrational needs.

Effective systems and processes were not in place to ensure staff were suitably trained on people’s needs. This meant people were at risk of receiving unsafe care and treatment.

The registered manager and staff told us they used an app on the phone and referred to care records in people’s homes. Daily records were completed by staff after each visit which showed the care delivered and the competency of staff was assessed through spot checks. However, this was not effective. A relative told us, “[Registered manager] tries to support the carers but the follow through [from staff] is not good.”

Feedback from people and relatives showed inconsistencies with the care and support people received from the service. One person told us, “The carers I have are good, they know how to help me and they help me wash and cream my legs for me and they talk to me.” A relative told us, “The staff are well trained and very helpful.” Another relative told us, “They [staff] are all very good, they do everything we need and understand.”

However, a relative told us, “The carers don’t have any understanding of Motor Neurone Disease MND.” Another relative told us, “The carer comes in and doubles up, and they are not always adequately trained.” A third relative told us, “[Person] needs someone confident and reassuring as one of the carers are but it’s pot luck, one carer should always be competent.”

Records showed staff had completed training the provider considered mandatory in areas such as safeguarding, learning disability, health and safety, challenging behaviour, moving and handling, dementia care, medication, infection control, MCA and DoLS and food hygiene and received formal supervision. However, improvement was needed, as feedback from relatives showed some staff were not competent with moving and handing despite having completed the training.

There was no training matrix in place and staff had not received formal training in relation to specific areas people needed support with such as stroke, MND, nasojejunal (NJ) feeding tube, stoma and catheter care.

We spoke to the registered manager about staff training. They told us they had trained staff in areas such as stoma and catheter care, however staff needed to be trained by a qualified professional in specialised areas of care and certified that they were competent to provide support in these areas. Despite the registered manager confirming that staff needed to be trained by qualified professionals, staff had not received this training, despite supporting individuals with complex care needs.

There were no care plans in place for staff to have access to information about people’s needs and guidance on support they required in accordance with their individual health conditions. A staff member told us, “There is no written guidance in place [in relation to stoma and catheter care], I was just shown what to do.”

People were supported to access healthcare services when required. The registered manager worked in partnership with other services such as the district nurses, social workers and occupational therapists to deliver effective and timely care. A healthcare professional told us, “Communication has been excellent. [Registered manager] keeps me regularly updated on how [person] is doing, any concerns that arise, and progress made. Risks are handled sensibly and discussed openly, both during assessments and as part of regular follow-up. We are consistently impressed with TIG Heaven. [Registered manager], in particular, has gone above and beyond.”

A relative told us, “They [staff] spot bed sores really quickly and one time recently they wanted the District Nurse in and the manager phoned and checked if they had been and then followed it up and got the night District Nurse to come out on the 3rd day because they hadn’t been. They kept in touch with me all the time.” Another relative told us, “The District Nurse will come out if there are any pressure sores. The physio comes in regularly too for exercise and to give advice.”

Records showed people’s needs were monitored. However, when there was a change in people’s needs, care records did not always detail the changes and the appropriate support people required with their ongoing care and treatment.

For example, for 1 person who used mobility aids, their monitoring review record stated there was improvement in their mobility and their needs had changed since the last review. For another person, their care needs had changed from 2 carers to 1 carer. However, both care records had not been updated to reflect the support people required in response to changes in their care needs.

A relative told us, “A carer who sees [person] once a week, had come in with another carer who had not been for a while. The carer gave the [person] their meds incorrectly. I asked the carer if there had been an update about the changes in March 2025, but the carer had not had an update from their colleague.” Another relative told us, “There is no current care plan, there were changes in March and no changes in documents. There is no care plan in the folder, there is a daily log. There are instructions for medication but no date on that. [Name of medication] has been removed but it’s still on the form.” Therefore, we could not be assured there was a robust system in place which provided effective oversight with monitoring outcomes of people’s care as care plans were not in place which clearly documented people’s needs.

Effective systems and processes were not in place to ensure the service acted in accordance with the provisions of Mental Capacity Act (MCA) 2005 and peoples’ best interests were protected. Care records did not contain any information about a person’s mental capacity and levels of comprehension. For example, in one person’s care records, it stated ‘short term memory, able to communicate,’ with no further explanation. If a person lacked capacity, there were no records to demonstrate that mental capacity assessments had been undertaken and the best interest decision making process was followed, which would include involving relatives and healthcare professionals. Care records had not been signed by people or where appropriate, their family representatives to indicate that they had consented to their care.

There were MCA policies in place and staff had received MCA training. People and relatives told us staff sought their consent before supporting them with their care and treatment. A person told us, “I control my care. I know what they should be doing and that is what they do.” A relative told us, “The carers talk to [person] a lot and always ask them for consent to anything they help them with.”